Maternal obesity and inappropriate gestational weight gain (GWG) increase both maternal and neonatal morbidity and mortality. In addition, offspring of obese women are at increased risk for neurodevelopment delay, becoming obese, and developing metabolic diseases. Women who are socio-economically disadvantaged (SED), especially from African American (AA) populations, are particularly susceptible to adverse pregnancy-related outcomes because of their high prevalence rates of obesity. Therefore, successful weight management during pregnancy in SED, AA women has considerable public health implications. We have experience in testing lifestyle interventions among SED non-pregnant women that have been implemented and sustained within community organizations such as Parents As Teachers (PAT), a national home visiting program that provides parent-child education and services free-of-charge to high needs women, prenatally and post-partum, through up to 25 home visits per year until kindergarten. We propose to conduct a 24-month (6-month prenatal and 18-month post-partum) randomized, controlled trial in obese SED AA women to evaluate the ability of an innovative lifestyle intervention program (PAT-i-), delivered by PAT parent educators during prenatal and post-partum home visits, to improve maternal and neonatal/infant weight, metabolic and health outcomes. An extensive programmatic evaluation will determine the applicability of the PAT+ intervention in real world settings by measuring programmatic reach, implementation, acceptability, and sustainability. If effective, PAT+ can be disseminated through this national organization, which currently reaches over 249,000 mothers and 319,000 children participating in 2,173 PAT programs across all 50 states. PUBLIC HEALTH RELEVANCE: This project will test a novel lifestyle intervention to help obese socioeconomically disadvantaged African American women achieve healthy weight control during and after pregnancy and improve the health of their offspring. The treatment will be given through an existing national home visiting program, Parents As Teachers, which will facilitate sustainability and nationwide dissemination, if effective.